State Vision Plan Coverage Overview
State Vision Plan offers comprehensive coverage including eye exams, frames, lenses, and contact lens services. Additional benefits are available for diabetics. No claims needed at network providers, with discounts on extra eyeglasses, contact lenses, and vision correction. Details on copayments, reimbursements, and member costs are provided for in-network and out-of-network services. Learn more about the benefits and coverage offered by PEBA in 2024 through the State Vision Plan.
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Vision care Insurance Benefits Training 2024
Important information This overview is not meant to serve as a comprehensive description of the insurance benefits offered by PEBA. More information can be found in the following: Benefits Administrator Manual; and Insurance Benefits Guide. The plan of benefits documents, certificates of coverage and benefits contracts contain complete descriptions of the insurance benefits offered by or through PEBA. Their terms and conditions govern all of these benefits. 2
State Vision Plan Coverage includes: Comprehensive eye exams; Frames; Lenses and lens options; and Contact lens services and materials. Discounts on extra pairs of eyeglasses, contact lenses, and LASIK and PRK vision correction. Additional benefits available for diabetics. Either frames/lenses or contact lenses, but not both, in the same plan year. 3
State Vision Plan No claims to file at network providers. Subscriber responsible for copayments and any charges remaining after allowances and discounts have been applied. Subscriber pays for services at out-of-network providers. EyeMed will reimburse for portion of expenses for certain services. List of network providers at eyemedvisioncare.com/pebaoe. Your Vision Coverage at a Glance flyer available at peba.sc.gov/nyb. 4
Exams In-network member cost Out-of-network reimbursement You receive: You pay: Exam, with dilation if necessary A $10 copay. Up to $35. Retinal imaging Up to $39. No reimbursement. 5
Frames and lenses In-network member cost Out-of-network reimbursement You receive: You pay: 80% of balance over $150 allowance. Frames Up to $75. Standard plastic lenses A $10 copay. Up to $55. Standard progressive lenses Premium progressive lenses A $35 copay. Up to $55. $35-$80 for Tiers 1-3. For Tier 4, you pay copay and 80% of cost less $120 allowance. Up to $55. 6
Contact lenses In-network member cost Out-of-network reimbursement You receive: You pay: Standard contact lenses fit & follow-up Premium contact lenses fit & follow-up Conventional contact lenses Disposable contact lenses A $0 copay. Up to $40. A $0 copay and receive 10% off retail price less $40 allowance. Up to $40. A $0 copay and 85% of balance over $130 allowance. Up to $104. A $0 copay and balance over $130 allowance. Up to $104. 7
2024 Monthly premiums Premiums for optional employers may vary. Use Monthly premium worksheet for optional employers. Employee/ spouse Employee/ children Employee Full family Vision $6.30 $12.60 $13.54 $19.84 8
Disclaimer This presentation does not constitute a comprehensive or binding representation of the employee benefit programs PEBA administers. The terms and conditions of the employee benefit programs PEBA administers are set out in the applicable statutes and plan documents and are subject to change. Benefits administrators and others chosen by your employer to assist you with your participation in these employee benefit programs are not agents or employees of PEBA and are not authorized to bind PEBA or make representations on behalf of PEBA. Please contact PEBA for the most current information. The language used in this presentation does not create any contractual rights or entitlements for any person. 9
